RxSense Home Page

Cloud-based, secure, scalable adjudication

—with no downtime?

 

Makes Sense. 

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Whether you’re an established Pharmacy Benefit Manager or just starting out, RxSense will transform your business...

...and we'll do it without competing with you in the marketplace.

Business Plan

Transformative Model

We are specifically structured to support our client's growth by providing pass-through pricing,  visibility into their business, and complete flexibility to choose everything from a full- to self-service model, at their own pace.

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Interoperability

Our platforms, RxAgile® and RxIQ®, are built for interoperability across and between legacy and other healthcare systems via APIs, providing clients the access they need to vital health information essential in supporting clinical processes.

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Service Model

Our client-centered, ongoing service approach means you have an entire team working to ensure your success. From the strategic to the tactical, our service model is unrivaled in excellence and customer satisfaction.

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We're a technology partner, not just another vendor. We give you the freedom to operate and integrate just the services and systems you need to support your business model

Our approach to supporting private-label customers is entirely flexible. Some PBMs are just beginning their journey looking for everything to get to market faster. Other PBMs are mature businesses, just needing a more advanced technology, to help them be more efficient and leverage the scalability of a cloud-based platform.

 

Our business accelerators and fresh approach are truly differentiatingtaking your ability to manage your PBM business to new heights and new levels of efficiency, whether you're just starting out or you're an established enterprise.

  • Full Service - Self Service

  • Transparency

  • Bring Your Own Partners

  • Optional Pre-contracted Partners (Mail, Specialty)

  • No Black-Box Pricing

  • Pass-through Cost of Goods

  • Flexible Service Levels

PBM Adjudication

RxAgile is our advanced cloud-based platform for the transparent, comprehensive adjudication and administration of pharmacy claims.

Business Intelligence

RxIQ is our real-time analytics platform that puts in-depth analysis on your dashboard and insights you can act on and deploy immediately. 

Business Accelerators

Operationalized functionalitysuch as pre-contracted partners or automated analysis – designed to expedite your market entry or modernization initiatives.

Superior Support

Our industry-leading service model delivers the right mix of technological and operational support, what and when. you need it, 24/7/365.

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Adjudication should just work accurately and quickly.

RxAgile does, so you can focus on more important things—like data and analytics that help you move quickly to manage your business more effectively.

That’s why we empower you with total domination of your data and the automation of analysis—at your fingertips via RxIQ's intuitive UI—of both your core plan and financial data. And we also deliver proactive strategy and recommendations, leveraging automation and machine learning, to improve your business outcomes and optimize your members’ cost experience and connected health behaviors. And before you ask, interoperability isn't even a question with our APIs.

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Ready to accelerate your business?

Whenever you're ready, and only if you want, you can add on any (or all) of our business accelerators. Just imagine what advantages such as faster speed-to-market or extended platform capabilities that automate resource-intensive business operations would do for your business.

65k+ Pharmacies

Open network of over 65,000 pharmacies with flexibility to use as a wrap

Home Delivery

Pre-contracted mail order / home delivery service

Prior Authorization

Pre-contracted, turnkey, full-service partnership or self-service technology to operate your own program

Specialty

Pre-contracted specialty pharmacy offering convenience, cost control and member-centered care

24 / 7 / 365

Member and pharmacy contact center with comprehensive, client-specific knowledge base

Clinical Programs

Full clinical program support, with starter lists and templates; as well as adherence and member support, engagement,  pharmacogenomics partnerships

Limited Distribution

Pre-contracted, configurable, and comprehensive specialty limited distribution drug wrap

Formulary & Rebate

Formulary management and / or rebate contracting and administration and support 

Member Tools

Member portal and native iOS and Android apps that operate in your brand—or leverage our APIs to outfit your own member tools

We have the business accelerators you need to manage your PBM's growth.

 
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Branded Member Tools

 

Keep member experiences branded and intuitive 

Our member portal and apps are plug-and-play, brandable, and available to our private-label PBM clients. Alternatively, if you have your own portal, virtually all of the member portal’s capabilities can be pulled in via APIs. 

Pharmacy Locator

Limit display to only those pharmacies available to the client's / plan’s network selection

Robust Drug Search

Find drug information, interactions, along with  true member-pay price based on accumulators/benefit status

Secure & Compliant

HIPAA- and regulatory-compliant log-in displaying only the  information available to specific  member ID

Claims History

In a single click, view claim details, Rx specifics, product particulars, patient information

 
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It all starts with a great adjudication platform.

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A common-sense benefits management platform with an intuitive design.

 

Built specifically to provide an absolutely transparent and comprehensive adjudication engine. 

 

We offer the convenience and reliability of user-friendly, modern systems, an agile technology team focused on client needs with reliable turnaround times, and advanced technology that supports a full white-label experience.

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RxAgile is a cloud-based turnkey, white-label adjudication engine, with all the flexibility and simplicity needed to manage your business now and as it grows. 

Real Time Throughout

From being able to make an instant eligibility change or update to a clinical edit, to accessing real-time claims data and analysis through RxIQ, our integrated

analytics environment.

Multi-layered Security

Risk-based, multi-layered security approach throughout the environment from user-specific, role-based permissions, full encryption for data at rest and in transit, and native availability and redundancy across multiple data centers. (See security credentials.)

Efficiency

No longer dependent on IT and development resources or at the mercy of long development timelines when system changes need to be made. With RxAgile, it's not just benefit changes that are efficient. It's a lower cost position, greater accuracy and faster speed to market.

API-based

A central source of truth, such as member pricing tools that access the formulary and network you’ve just updated, always in sync, and instantly providing the current member-pay price.

Plan and Benefit Changes?
Watch this short video to see how easy it is make organizational changes to a complex plan design in RxAgile
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Super charge your business with intelligence you can use.

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Real-time Data and Analytics

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Analytics to revolutionize your business

With RxIQ, you know sooner, can course-correct faster, and more quickly optimize your plans. It has easy-to-use, dashboard-delivered analytics with simple drill-down capabilities . You can even provide your downstream clients with a private-labeled "news stand" environment where they can view and retrieve branded reports—or simply schedule those branded reports that you pre-configure for delivery right to their inbox.

RxIQ's strength is really in what you can do with all that data. Set up real-time alerts to clinicians or plan management to notify them about clinical or financial items. Or take advantage of our groundbreaking PBM Financial Operations module that leverages automation and machine learning to help you manage your PBM financial operations and performance. Now that's revolutionary.

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Regardless of your current pharmacy benefits business model, we have the platform solutions and expertise to power your growth intelligently. ​​

 

Who We Are

Learn more about our leadership and why we decided to build these platforms.

 

Transformative Model

Transparency, control, flexibility are all long over due. We got here as fast as we could.

 

RxAgile

Dig into more details about the claims adjudication engine that could.

 

Interoperability

This is table stakes for us. Find out just how well we do this.

 

RxIQ

Beyond reports, data, and analysis, find out what else RxIQ can do.

 

Service Model

We're here for you. In the way we wished our PBM was there for us and wasn't.

 

Business Accelerators

Whether you're new or been there, we've got an accelerator for you.

 

Careers

Join for the chance to do some seriously good work. (Ok, yes. We have cookies.)

 

Security & Continuity

We're rather proud of all the badges we've earned and the downtime we haven't had.


Press Center & Blog

People are taking notice and showering us with accolades.

 

Strategies

Our recommendations leverage automation and machine learning.

 

Contact Us

When you're ready to talk, we're ready to listen.